(1012) Pharmacists' Interventions in the ICU: A Quantified Study

Introduction: Patients in the ICU are provided with care by a multidisciplinary team. ICU team includes intensivists, pharmacists, respiratory therapists, dieticians, nurses, social workers, personnel in training, and others. Pharmacists are core members of this team and substantially impact the reduction of drug errors and costs, and maximizing patient safety. This study was carried out to quantify the impact of pharmacists in ICU.

Methods: This was prospective study conducted at tertiary medical center. Following exemption from IRB as safety project, two authors noted all suggestions made by pharmacists during rounds and whether they were accepted. All recommendations recorded were cross-checked with pharmacist after rounds. No identifying patient information was included. The recommendations were grouped into 7 categories: (i) Prevention of adverse drug event/interaction, (ii) Changes in drug formulation/route, (iii) Adjustment of parenteral nutrition, (iv) drug not prescribed despite indication, (v) Changes in drug of similar class (vi) Discontinuation of drugs (vii) Adjustment of dose.

Results: Over the period of 4 weeks (Mid-May to Mid-June 2023), 130 suggestions made. 114 were accepted - acceptance rate of 87.7% (114 vs 16). Among accepted recommendations, those suggesting initiation of a drug were most common. Overall, most of suggestions were regarding initiating a drug that was indicated but not ordered (n=45) followed by discontinuing a drug (n=40). Remainder of recommendations were regarding adverse effects with subsequent discontinuation/alteration of drug (n=2), changes in drug route/formulation (n=9), adjustment in parenteral nutrition composition (n=3), changes in drug therapy within same class (n=7), adjustment of dose (n=24). Antibiotic initiation/discontinuation (n=28), & suggestions regarding DVT prophylaxis (n= 23). Our study was limited by single-unit, not measuring clinical outcomes and absence of control group.

Conclusions: Our study shows the high importance of pharmacist in the ICU. Further studies involving a larger dataset and prospective design is suggested to fully evaluate the impact of this intervention. The cost-effectiveness of pharmacist intervention could also be studied and potentially more efficient utilization of resources.